Dr PAUL ANTONISSEN is a male medical professional, specializing in Nurse Practitioner. He graduated in 2018.
CLEANSLATE MEDICAL GROUP OF WISCONSIN SC
7201 GREEN BAY RD
KENOSHA
WI
531423532
Tel: 4135842173
| Npi | 1174096747 |
| Pac Id | 4688909401 |
| Professional Enrollment Id | I20190716000696 |
| Last Name | ANTONISSEN |
| First Name | PAUL |
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| Suffix | |
| Gender | M |
| Credential | |
| Medical School Name | OTHER |
| Graduation Year | 2018 |
| Primary Specialty | NURSE PRACTITIONER |
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| Organization Legal Name | CLEANSLATE MEDICAL GROUP OF WISCONSIN SC |
| Group Practice Pac Id | 4284905134 |
| Number Of Group Practice Members | 21 |
| Line 1 Street Address | 7201 GREEN BAY RD |
| Line 2 Street Address | |
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| City | KENOSHA |
| State | WI |
| Zip Code | 531423532 |
| Phone Number | 4135842173 |
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| Professional Accepts Medicare Assignment | Y |
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